Saint Louis University Journal of Health Law & Policy

Document Type

Student Comment


LGBTQ individuals face countless acts of discrimination in health care insurance and delivery. In spite of this inequality, there are zero LGBTQ-inclusive health insurance protections in over half of the United States. Title VII of the Civil Rights Act (Title VII) and Section 1557 of the Patient Protection and Affordable Care Act (ACA) are two federal statutes that prohibit discrimination, in relevant part, on the basis of sex. Both federal statutes have been greatly impacted by the Supreme Court decision in Bostock v. Clayton County, which interpreted “sex” in Title VII to include gender identity and sexual orientation. This Article explains how Bostock protects LGBTQ persons from discrimination in employer-provided health insurance under Title VII. Bostock’s scope extends beyond health insurance and into health care delivery, as demonstrated by its applicability to Section 1557 of the ACA (Section 1557). This Article demonstrates how Section 1557—where its enabling statutes do not include Title VII—should prohibit discrimination regardless of sexual orientation and gender identity. Lastly, this Article emphasizes the importance of state action, for example in public accommodations laws, in the absence of clear and explicit federal LGBTQ protections.